Healthcare Provider Details

I. General information

NPI: 1245565654
Provider Name (Legal Business Name): ACTIVE HOME HEALTH CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2009
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 W 95TH ST
OAK LAWN IL
60453-2401
US

IV. Provider business mailing address

5009 W 95TH ST
OAK LAWN IL
60453-2401
US

V. Phone/Fax

Practice location:
  • Phone: 708-499-2622
  • Fax: 708-499-9466
Mailing address:
  • Phone: 708-499-2622
  • Fax: 708-499-9466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number1011140
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name: DR. KHALED HUSSEIN
Title or Position: ADMINISTRATOR
Credential: DPT
Phone: 708-499-2622